TARGETED SURGICAL APPROACH TO MULTIPLE CEREBRAL HYDATID CYSTS WITHOUT SYSTEMIC INVOLVEMENT

Abstract

Background The adult Echinococcus Granulosus resides in the intestines of dogs. Infectious eggs are excreted in the feces. Hydatid infections can affect multiple organs, with the liver being the most commonly involved, followed by the lungs and spleen. Less frequently, the brain, spine, retroperitoneal space, kidneys, and musculoskeletal system can also be affected. Case Presentation A 55-year-old male from a rural area, who owns sheep and dogs, presented with symptoms such as poor coordination in his right hand, agraphia, and acalculia. One week prior to admission, he had a sudden loss of consciousness. CT and MRI scans revealed six distinct cystic lesions in the left parietal lobe, extending towards the lateral ventricle. These lesions were well-defined, non-enhancing, and showed minimal perilesional edema. Whole body CT scan showed no additional cysts. Results After comprehensive investigations, the patient underwent surgery. A left parietal craniotomy was performed, followed by a C-shaped durotomy. Intraoperative ultrasound was utilized to locate the cysts. A minimal corticectomy was made at the posterior border of the parietal lobe. This exposed a cluster of six hydatid cysts located 1 cm subcortically. The cysts were carefully dissected and individually removed using the Dowling-Orlando technique. The remaining cavity was then flushed with a hypersaline solution. The patient recovered well, with no new neurological. He received therapy with albendazole second day after surgical intervention. Histopathological examination confirmed the diagnosis of hydatid cysts. The patient was discharged on the 10th postoperative day. Discussion The Dowling-Orlando technique is a highly effective surgical method for removing cerebral hydatid cysts without causing rupture. Magnification is recommended during the early stages of surgery to avoid damaging the fragile cyst wall and to establish the precise surgical plane. Saline solution is used to dissect the cyst wall from the brain tissue and aid in the removal of the hydatid. Tilting the operation table towards the lesion site and lowering the patient's head assists in the gravity-assisted removal of the cyst.

Keywords

• cerebral hydatid cyst
• echinococcus granulosus
• Dowling-Orlando technique
• albendazole therapy
• intraoperative ultrasound